Introduction: Total
knee arthroplasty, being a major surgery, carries a risk of post-operative deep
vein thrombosis (DVT). The main objective of the present study was to elucidate
the association of clinical, laboratory, and echographic findings with the
occurrence of DVT. Patients and Methods: The present study was
prospective and non-randomized, with restricted exclusion criteria. Forty
patients were submitted to total knee arthroplasty due to osteoarthritis.
Patients were clinically evaluated by laboratory tests, assessment of pain and
calf circumference, and the presence of Homans’ sign. Echo Doppler was
performed in each patient on postoperative day 7. The echographic evaluation
divided the patients into two groups: positive (G1) and negative for thrombosis
(G2). All patients received prophylactic heparin during the 7-day hospital
admission. Results: Eleven patients complained of pain (analgesic
medication was used during the entire admission). Leg circumference variation
from the pre-operative period to post-operative day 7 was: G1, 1.70 ± 1.12 cm
and G2, 0.68 ± 1.25 cm (p = 0.03). Homans’ sign was considered positive in 10
patients. Echographic evaluation was positive in 11 patients (27.5%). No cases
of pulmonary embolism, infection, or death were observed. Conclusions: The incidence of DVT was 27.5%, with an increase in leg circumference being the
main predictive factor (p = 0.03).
References
[1]
Shimoyama, V., Sawai, T., Tatsumi, S., Nakahira, J., Oka, M., Nakajima, M., Jotoku, T. and Minami, T.J. (2012) Perioperative Risk Factors for Deep Vein Thrombosis after Total Hip Arthroplasty or Total Knee Arthroplasty. Journal of Clinical Anesthesia, 24, 531-536.
[2]
Chotanaphuti, T., Ongnamthip, P.,, Songpatanasil, T., Veerapan, P. and Deeprecha, K. (2007) Risk Factors of Deep Vein Thrombosis (DVT) after Total Knee Arthroplasty (TKA) at Phramongkutklao Hospital. Journal of the Medical Association of Thailand, 90, 485-491.
[3]
White, R.H., Romano, P.S., Zhou, H., Rodrigo, J. and Bargar, W. (1998) Incidence and Time Course of Thromboembolic Outcomes Following Total Hip or Knee Arthroplasty. Archives of Internal Medicine, 158, 1525-1531. https://doi.org/10.1001/archinte.158.14.1525
[4]
Lieberman, J.R., Huo, M.M., Hanway, J., Salvati, E.A., Sculco, T.P. and Sharrock, N.E. (1994) The Prevalence of Deep Venous Thrombosis after Total Hip Arthroplasty with Hypotensive Epidural Anesthesia. Journal of Bone and Joint Surgery-American Volume, 76, 341-348. https://doi.org/10.2106/00004623-199403000-00004
[5]
Esmon, C.T. (2009) Basic Mechanisms and Pathogenesis of Venous Thrombosis. Blood Reviews, 23, 225-229. https://doi.org/10.1016/j.blre.2009.07.002
[6]
Maradit Kremers, H., Larson, D.R., Crowson, C.S., Kremers, W.K., Washington, R.E., Steiner, C.A., Jiranek, W.A. and Berry, D.J. (2015) Prevalence of Total Hip and Knee Replacement in the United States. Journal of Bone and Joint Surgery-American Volume, 97, 1386-1397. https://doi.org/10.2106/JBJS.N.01141
[7]
Markovic-Denic, L., Zivkovic, K., Lesic, A., Bumbasirevic, V., Dubljanin-Raspopovic, E. and Bumbasirevic M. (2012) Risk factors and Distribution of Symptomatic Venous Thromboembolism in Total Hip and Knee Replacements: Prospective Study. International Orthopaedics, 36, 1299-1305. https://doi.org/10.1007/s00264-011-1466-5
[8]
Kang, J., Jiang, X. and Wu, B. (2015) Analysis of Risk Factors for Lower-Limb Deep Venous Thrombosis in Old Patients after Knee Arthroplasty. Chinese Medical Journal (Engl), 128, 1358-1362. https://doi.org/10.4103/0366-6999.156782
[9]
Evans, M.F. and Frank, J. (1997) Can We Diagnose Deep-Vein Thrombosis Clinically? Canadian Family Physician, 43, 1069-1070.
[10]
Francis, C.W., Ricotta, J.J., Evarts, C.M. and Marder, V.J. (1988) Long-Term Clinical Observations and Venous Functional Abnormalities after Asymptomatic Venous Thrombosis Following Total Hip or Knee Arthroplasty. Clinical Orthopaedics and Related Research, 232, 271-278. https://doi.org/10.1097/00003086-198807000-00034
[11]
Prandoni, P., Lensing, A.W., Cogo, A., Cuppini, S., Villalta, S., Carta, M., Cattelan, A.M., Polistena, P., Bernardi, E. and Prins, M.H. (1996) The Long-Term Clinical Course of Acute Deep Venous Thrombosis. Annals of Internal Medicine, 125, 1-7. https://doi.org/10.7326/0003-4819-125-1-199607010-00001
[12]
Kesieme, E., Kesieme, C., Jebbin, N., Irekpita, E. and Dongo, A. (2011) Deep Vein Thrombosis: A Clinical Review. Journal of Blood Medicine, 2, 59-69. https://doi.org/10.2147/JBM.S19009
[13]
Woolson, S.T. and Pottorff, G. (1991) Venous Ultrasonography in the Detection of Proximal Vein Thrombosis after Total Knee Arthroplasty. Clinical Orthopaedics and Related Research, 273, 131. https://doi.org/10.1097/00003086-199112000-00019
[14]
Grady-Benson, J.C., Oishi, C.S., Hanson, P.B., Colwell Jr., C.W., Otis, S.M. and Walker, R.H. (1994) Postoperative Surveillance for Deep Venous Thrombosis with Duplex Ultrasonography after Total Knee Arthroplasty. Journal of Bone and Joint Surgery-American Volume, 76, 1649-1657. https://doi.org/10.2106/00004623-199411000-00008
[15]
Ciccone, W.J., Fox, P.S., Neumyer, M., Rubens, D., Parrish, W.M. and Pellegrini Jr., V.D. (1998) Ultrasound Surveillance for Asymptomatic Deep Venous Thrombosis after Total Joint Replacement. Journal of Bone and Joint Surgery-American Volume, 80, 1167-1174. https://doi.org/10.2106/00004623-199808000-00010
[16]
Kraay, M.J., Goldberg, V.M. and Herbener, T.E. (1993) Vascular Ultrasonography for Deep Venous Thrombosis after Total Knee Arthroplasty. Clinical Orthopaedics and Related Research, 286, 18-26. https://doi.org/10.1097/00003086-199301000-00005
[17]
Thomas, M.L. and MacDonald, L.M. (1978) Complications of Ascending Phlebography of the Leg. British Medical Journal, 2, 317-318. https://doi.org/10.1136/bmj.2.6133.317
[18]
Larcom, P.G., Lotke, P.A., Steinberg, M.E., Holland, G. and Foster, S. (1996) Magnetic Resonance Venography versus Contrast Venography to Diagnose Thrombosis after Joint Surgery. Clinical Orthopaedics and Related Research, 331, 209-215. https://doi.org/10.1097/00003086-199610000-00029
[19]
Lapidus, L.J., Ponzer, S., Pettersson, H. and de Bri, E. (2013) Symptomatic Venous Thromboembolism and Mortality in Orthopaedic Surgery—An Observational Study of 45968 Consecutive Procedures. BMC Musculoskeletal Disorders, 14, 177. https://doi.org/10.1186/1471-2474-14-177
[20]
Lee, W.S., Kim, K.I., Lee, H.J., Kyung, H.S. and Seo, S.S. (2013) The Incidence of Pulmonary Embolism and Deep Vein Thrombosis after Knee Arthroplasty in Asians Remains Low: A Meta-Analysis. Clinical Orthopaedics and Related Research, 471, 1523-1532. https://doi.org/10.1007/s11999-012-2758-9
[21]
Hernandez, A.J., Almeida, A.M., Fávaro, E. and Sguizzato, G.T. (2012) The Influence of Tourniquet Use and Operative Time on the Incidence of Deep Vein Thrombosis in Total Knee Arthroplasty. Clinics, 67, 1053-1057. https://doi.org/10.6061/clinics/2012(09)12